#0878

Elevating Surgical Standards: Analyzing Morbidity and Mortality in Radical Cystectomy across Volume-Based Centers

S. Sii^1,2, S. Chopra², C. Perumalla², M. Weerakoon², C. Vernon²

¹Austin Health, Urology, Melbourne, Australia
²Sunshine Coast University Hospital, Urology, Sunshine Coast, Australia

Introduction:

Radical cystectomy (RC) is the current gold-standard treatment for muscle-invasive bladder cancer (MIBC) but is associated with notable morbidity and mortality risks. Although advancements in surgical techniques and peri-operative care have improved outcomes, challenges remain. Current European Association of Urology (EAU) guidelines define high-volume centers as those performing over 20 radical cystectomies per year. This study evaluates the impact of surgical volume on morbidity and mortality outcomes following open radical cystectomy (ORC). This includes a comparison of outcomes from a regional center performing a minimum of 10 ORC annually to those from established high-volume centers (≥20 ORC/year).

Material and methods:

This retrospective cohort study analyzed patients who underwent ORC for urothelial malignancy at a 700-bed regional hospital in Australia, from 2018 to 2022. Key outcome measures included length of hospital stay, 30-day, 90-day, and 1-year all-cause mortality rates, as well as complication rates categorized by the Clavien-Dindo classification system. Comparative analyses were conducted against existing literature from recognized high-volume centers in Australia and the UK.

Results:

The study reviewed data from 64 patients, revealing a 30-day mortality rate of 1.83% and a 90-day mortality rate of 1.87%, comparable to New South Wales and UK rates. The 1-year all-cause mortality rate was observed at 3.65%. The median hospital length of stay was 13 days, exceeding the UK cohort average of 11 days. Complications classified as Clavien-Dindo grade I/II occurred in 49.1% of cases, significantly lower than the UK rate of 60.9%. Moreover, rates of grade III+ complications were markedly reduced at 18.8% compared to 31.4% in high-volume centers. These findings indicate that effective surgical practices can achieve favorable outcomes even in moderate-volume settings.